Tocilizumab Reduces Lung Injury in a Rat Lung Ischemia and Reperfusion Model.

OBJECTIVE: In this study, the effect of tocilizumab (TCZ) on lung tissue in lung ischemia-reperfusion (I/R) injury in rats was investigated. MATERIAL AND METHODS: A total of 24 Wistar rats were divided into 4 equal groups, with 6 rats in each group: Left lung I/R was applied to I/R groups. In the I/R groups, the left lung hilum was clamped for 45 minutes, and then the clamp was removed and reperfused for 120 minutes. In the TCZ groups, 4 mg/kg and 8 mg/kg of TCZ were administered intraperitoneally to the rats 30 minutes before surgery. RESULTS: The tumor necrosis factor-alpha mean value was not statistically significant between the groups (P = .091). Statistically significant results were observed between group I/R-TCZ (8 mg/kg) and group I/R for catalase. (P = .005). Statistically significant results were observed between group I/R-TCZ (8 mg/kg) and group I/R for malondialdehyde. (P = .009). The difference in total ischemia score between group I/R-TCZ (4 mg/kg) and group I/R-TCZ (8 mg/kg) and group I/R was statistically significant (P < .001). In terms of alveolar hemorrhage, there was a statistically significant difference between group I/R-TCZ (4 mg/kg) and group I/R-TCZ (8 mg/kg) and group I/R (P = .01 and P = .002, respectively). There was a statistically significant difference between group I/R-TCZ (8 mg/kg) and group I/R in terms of neutrophil accumulation (P = .01). In terms of interstitial edema, there was a statistically significant difference between group I/R-TCZ (4 mg/kg) and group I/R-TCZ (8 mg/kg) and group I/R (P = .006 and P = .001, respectively). In terms of pulmonary edema, there was a statistically significant difference between group I/R-TCZ (4 mg/kg) and group I/R-TCZ (8 mg/kg) and group I/R (P = .01 and P = .009, respectively). CONCLUSION: Lung tissue may be affected by I/R injury and this damage can be reversed with the use of TCZ.

Estimation of Reference Change Value and Biological Variation of Creatinine Measurements in Healthy Individuals.

INTRODUCTION: The aim of the this study was to assess the biological variation and reference change value (RCV) for creatinine in healthy individuals aged 18 - 45 years using both Jaffe and enzymatic methods. METHODS: Blood samples were collected from ten females and ten males, for four consecutive weeks in our labora-tory between November and December 2018. Samples were stored at -80°C before analysis and dissolved in one run and analyzed in duplicate in a single study with the Beckman Coulter AU2700 biochemistry analyzer. Data was evaluated using CV-ANOVA, and analytical (CVA), intra-individual (CVI), and inter-individual (CVG) variations were calculated. The RCV was calculated using the formula. RESULTS: The average CVA calculated at 95% confidence interval for creatinine using Jaffe's method was 2.51%, CVI was 4.51%, and CVG was 14.17%. The same measures for creatinine were 2.43%, 4.21% and 13.69%, respectively, using the enzymatic method. The individuality index (II) was 0.32 for the Jaffe's method and 0.31 for the enzymatic method. The average RCV calculated bilaterally in the 95% confidence interval for the Jaffe's and enzymatic methods were 14.26 and 13.43, respectively. CONCLUSIONS: This manuscript has underlined the fact that the II of creatinine is less than 0.6 indicating that the use of population-based reference intervals is limited, and interpretation of the RCV and analysis might be a more objective approach. Taken together, these results suggest that it could be valuable to calculate biological variation correctly and increase clinical awareness.

Analysis of Prescribed Critical Values in Istanbul Training and Research Hospital Biochemistry Laboratory: Should Critical Values Be Repeated?

BACKGROUND: Clinically important critical values must be readily available to the clinician. Repeating critical values may cause a delay. In this study, we evaluated the requirement of repeating critical values. METHODS: We extracted initial and repeated critical values and reporting times for a six-month period via the hospital laboratory information management system. Ten parameters from our critical value list (glucose, urea, mag-nesium (Mg++), calcium (Ca++), sodium (Na+), potassium (K+), chloride (Cl-), white blood cells (WBC), platelets, hemoglobin) were evaluated. We assessed whether the difference between the first measurement of the initial critical value and the repeated measurement value exceeded total allowable error (TEa). RESULTS: Repeated critical values of Mg++, Ca++, WBC, platelets, and hemoglobin did not exceed TEa. However, repeated critical values of glucose, urea, Na+, K+, and Cl- did exceed TEa. In addition, parameters such as glucose and urea did not affect the clinical decision although their critical values exceeded the TEa. This study showed that critical values for Na+, K+, and Cl- may need to be repeated. CONCLUSIONS: Each laboratory should assess the requirement of repeating critical values under its own operating conditions and, accordingly, establish and implement a suitable policy.

Obesity and obstructive sleep apnea syndrome.

OBJECTIVES: to investigate the association of sleep apnea severity with insulin resistance, leptin, adipose-fatty acid binding protein (A-FABP) and visfatin levels and to evaluate the confounding role of obesity. STUDY DESIGN: prospective study. METHODS: the study included obese patients who were referred to the sleep laboratory. Patients were divided into two main groups according to their Apnea-Hypopnea Index (AHI). Measurements of body weight, height, blood pressure, waist circumference (WC), and neck circumference (NC) were taken on the night of the sleep study. Blood samples were taken after polysomnography. Insulin resistance was estimated with the homeostasis model assessment (HOMA) index. RESULTS: group A included 34 patients with obstructive sleep apnea syndrome (OSAS) and group B included 19 patients without OSAS. OSAS patients had significant higher visfatin levels; however, other parameters were similar. Leptin and A-FABP were significantly correlated with body mass index (BMI) in both groups. OSAS patients had significant higher NC and WC despite a BMI similar to that of group B, and strong correlations of these two variables were found with HOMA. Group A had higher visfatin levels than did group B. CONCLUSIONS: insulin resistance was not directly associated with BMI and/or AHI, but it was aggravated by nocturnal hypoxemia owing to apnea severity. NC was also a good predictor for insulin resistance and should not be ignored during the treatment selection for the patients with OSAS. Visfatin may have a potential role as a screening marker for OSAS.